Provider Demographics
NPI:1629853759
Name:CLANTON, KALA (LCMHCA)
Entity Type:Individual
Prefix:MISS
First Name:KALA
Middle Name:
Last Name:CLANTON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 VALCOURT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3684
Mailing Address - Country:US
Mailing Address - Phone:206-618-0309
Mailing Address - Fax:
Practice Address - Street 1:5309 VALCOURT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3684
Practice Address - Country:US
Practice Address - Phone:206-618-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health